Integration of addiction treatment and behavioral therapies in comprehensive liver transplantation care to augment adherence and reduce alcohol relapse

Abstract

BackgroundLiver transplantation (LT) is the only definitive, life-saving treatment for patients with end-stage liver disease (ESLD). Few attempts have been made to summarize the current literature on the delivery of behavioral and addiction therapies to patients, both pre- and post- LT, to increase sobriety (especially in alcohol-related ESLD) and adherence, rendering providers without guidance for ideal timing, treatment components, and duration of aforementioned therapies. MethodsThis review summarizes the literature on alcohol relapse and medical adherence specific to the LT transplant population, and comprehensively compiles and evaluates behavioral therapies and addiction treatment programs instituted in the management of LT patients and those with liver disease etiologies that may lead to LT transplant (primarily alcoholic liver disease). ResultsOptimization of LT outcomes and patient survival depends on interventions focused on addressing alcohol relapse and medical adherence. Modifiable factors contributory to nonadherence and alcohol relapse in ESLD and LT patients should be addressed with systematic integration of behavioral therapies and addiction treatments within comprehensive liver transplant care. ConclusionImplementation of therapies inclusive of individual and/or group approaches to deliver motivational, cognitive-behavioral, self-improvement and pharmacological interventions in an integrated, multidisciplinary fashion is imperative to impart comprehensive care to transplant patients.